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Reprinted from the Transactions of the College of Physicians of Philadelphia, 1905. 



SOME PERSONAL RECOLLECTIONS OF THE CIVIL 

WAR/ 



By S. weir MITCHELL, M.D., LL.D., 

CORRESPONDING HONORARY MEMBER OF THE FRENCH ACADEMY OF MEDICINE. 



The story of the part played in the Civil War by our profession 
is nowhere told in a satisfactory manner. Histories of regiments, 
war biographies from private to general, the countless volumes of 
the rebellion record, relate the tale of battles lost or won, and of 
the military glory commemorated by monuments or rewarded by 
pensions. Except as to our technical story we alone are unre- 
corded. 

I know of no book which tells the personal life of a war sur- 
geon; what he did day by day on the field or in the hospital. 
I can imagine that such a book might be very interesting, and 
there are men in our own mitlst who could tell the story, and tell 
it well. It would have its romance, its pathos, its humor. 

Surgeon I/Ctterman left a volume giving an account of service 
with the Potomac army. It is a briefly told story of the difficul- 
ties of the army surgeon and what was required of him in the 
field. 

There are men here to-night of whose careers as brilliant and 
courageous war surgeons most of you know nothing. They are 
quiet gentlemen who no longer talk war, and it might be well 
for some of you to read with what respect and admiration the 
surgeon-in-chief of the Potomac army speaks of the competence of 
William Thomson and John II. Brinton. 

The other book on the history of the war is in the form of an 
official history of the medical department of the United States 

1 Read April 5, 1905. 






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2 MITCHELL: RECOLLECTIONS OF THE CIVIL WAR 

Army by Harvey E. Brown, and was published by the surgeon- 
general's office in 1873, but has been long out of print. The 
portion which deals with the rebellion is not more than thirty- 
five or forty pages. It has the dry, technical quality of official 
records and does no justice to a subject which should tempt 
some abler pen. 

When on April 12, 1861, we heard with shame and anger, such 
as few here can realize, that the flag had been fired on at Fort 
Sumter, the medical department of the army consisted of 30 
surgeons and 83 assistants. Of these 24 resigned to take part 
in the rebellion and 3 were dismissed for disloyalty; 13 were 
natives of the South, but stood true to the flag. Two surgeon- 
generals, owing to death or resignation, succeeded one another 
rapidly, and finally, soon after the beginning of the war, it was 
found necessary, owing to age, to permit the surgeon-general, 
who had difficulty in fulfilling the duties of that office, to retire. 
He was an old army surgeon; had done excellent work, but was 
<quite unfitted to meet the task which fell upon a totally unpre- 
pared nation. Owing largely to the great pressure made by the 
sanitary commission and the profession, his place was filled by lift- 
ing from the rank of an assistant surgeon Dr. William A. 
Hammond. He fell at once into an enormous business spread- 
ing over great spaces of country, increasing in perplexity, and 
making fresh demands every week, and at last so large that 
there was expended for ice alone in one year more than the 
whole amount of money which in peace sufficed for the entire 
medical service of the army. The organization also demanded 
complete revision. The surgeons of volunteers had to learn 
their surgery at bitter cost to many a wounded man. The reg- 
ular army surgeons were little used to seeing grave wounds, 
and, as the surgeon-general said, there was not an aspect of 
his work which was not foggy with embarrassments. 

Whatever else may be thought or said of William A. Hammond, 
nothing is more sure to me than that he duly saw and grasped a 
great opportunity; that he served his country as few could have 
done; that he created the Army Medical ^iuseum; that he saw the 






Ms- 



MITCHELL : RECOLLECTIONS OF THE CIVIL AVAR 6 

need for and advised the creation of the Army Medical School ; that 
he pointed out the men who were to direct the Army Museum 
and the Army Library. Until the end of his army career he 
was the unfailing friend of scientific study, and created special 
hospitals for diseases of the heart, lungs, and neural maladies. 
For this latter I and others have especially to thank him, and 
personally I owe him thanks for chances which modified valuably 
my entire medical life. 

The great need for medical and surgical help caused the crea- 
tion of hospitals in and about our great cities. This subject 
might occupy an hour, but suffice it to say that there were 
around this city upward of 25,000 beds at one time in hospitals 
constructed and admirably managed by men who were in many 
cases fresh from civil life. As concerns this, and all other depart- 
ments of the service, it may be said that at the end of the third 
year of the war the service had never been equalled. I doubt a 
little, .even with what we hear now, whether it has ever yet been 
excelled. To take medical charge of the vast army put into the 
field two new grades were created, that of brigade surgeon and 
medical cadet. In the latter rank were Collins Warren, John 
Curtis, Professor Tyson, and among others my brother Edward, 
who died in service a victim to duty and a prey to diphtheria in 
the Douglass Hospital at Washington. 

It became also necessary to provide additional help in the hos- 
pital service, and this was supplied by employing what were 
known as acting assistant surgeons. They served at home, but 
were liable to be called into duty in the field. Except in the 
case of Antietam and Gettysburg this was rare. Among these 
were Agnew, Gross, Morton, Stille, Da Costa, Harry Hart and 
many more. 

Before leaving the subject of the personnel of the war I return 
for a moment to the service of Surgeon-General Hammond. I 
have spoken of his great usefulness, of his large grasp of the 
immense business of the war. He had, however, defects which 
lessened his influence. An impulsive temperament and great 
self-confidence led him into inconsiderate action, as when, seeing 



4 MITCHELL : RECOLLECTIONS OF THE CIVIL WAR 

that the Western volunteer surgeons were using mercury in excess, 
the surgeon-general issued an order stopping all use of calomel. 

It was, of course, disobeyed or disregarded. 

A word more as to the position of the army surgeon. He fired 
no shot, but was often forced to operate under fire, was greatly 
exposed, and, as statistics show, suffered seriously. I am indebted 
to the surgeon-general of the army for the following statement of 
casualties in the medical corps: 

March 31, 1905. 
In reply to your note to the Surgeon-general, I find that of the medical 
officers of the Union Army during the War of Secession 41 were killed, 83 
wounded, of whom 10 died: 4 died in prison, and 281 of disease incident to 
active service. 

I regret that we have no statistics of the losses among medical officers in 
the Confederate Service. 

Very truly yours, 

J. R. Kean. 

In Brown's Medical Notes the matter of exchange of non-com- 
batant officers is fairly well dealt with. It was an irregular 
business. In some cases they were returned, and in others were 
held by the enemy. Some of them were as long as a year in 
rebel prisons. In many cases surgeons on both sides remained 
with their own wounded after defeat. Toward the close of the 
war I am under the impression that neither side held the sur- 
geons who thus elected to become prisoners, but there was no 
constant rule of action. 

I remember that when I inspected Fort Delaware I found 
there over forty surgeons, many of whom had been classmates of 
my own. 

My own service in the war was in the grade of contract sur- 
geon. I was only once called into the field, and that was after 
the third day of the Gettysburg fight. 

One of the earliest hospitals established here was in the old 
armory building at Sixteenth and Filbert. I there began my 
first hospital service with, if I remember rightly, Dr. Breed as 
the head of the hospital. It may amuse you to know that the 



MITCHELL: RECOLLECTIONS OF THE CIVIL WAR 

•only account of that hospital is to be found in my first novel, 
In War Time. 

I began here to take interest in cases of nervous diseases, which, 
at that time, nobody desired to keep for the reason that they were 
so little understood and so unsatisfactory in their results. I was 
therefore allowed to accept these cases from other wards, trans- 
ferring in return ordinary types of disease. When this became 
known to the surgeon-general he was at once interested and set 
aside a larger ward for neural maladies. When this overflowed 
with cases we took over the building known as Moyamensing Hall, 
on Christian Street. This was opened May 5, 1862, and closed 
October 29, 1864. Dr. Morehouse and Dr. Keen, then acting 
assistant surgeons, were ordered hither, and Dr. I. P. Reese, 
U. S. A., was placed at the head of the hospital. It was entirely 
devoted to nervous diseases, and very soon also to injuries of 
nerves. 

Again the space proving insufficient, a suburban estate on 
Turner's Lane was rented in August, 1862, and pavilions built 
for 400 men. One was assigned to Da Costa, and afforded him 
a chance for a classical study of exhausted hearts and for other able 
papers. With Drs. Morehouse, Wm. W. Keen, and Surgeon Alden, 
as surgeon in chief, and by a special order relieved of much of 
the time-killing, red-tape business, we set to work. Both More- 
house and I had at that time increasing general practice, but a 
morning visit to the hospital disposed of the routine work, and 
about 3 P.M. or later we went back. Keen, Morehouse, and 
I worked on at note-taking often as late as 12 or 1 at night, and when 
we got through walked home, talking over our cases. Usually the 
work took four or five hours, and we did it all in person. The 
late hours came two or three times a week, and usually followed 
an inflow of cases of injuries to nerves after some serious battle. 

I have worked with many men since, but never with men who 
took more delight to repay opportunity with labor. The oppor- 
tunity was indeed unique, and we knew it. The cases were of 
amazing interest. Here at one time were eighty epileptics, and 
every kind of nerve wound, palsies, choreas, stump disorders. I 



b MITCHELL: RECOLLECTIONS OF THE CIVIL WAR 

sometimes wonder how we stood it. If urgent calls took us back 
into town, we returned to complete the work. In fact it was 
exciting in its constancy of novel interests. 

Thousands of pages of notes were taken. There were many 
operations and frequent consultations. About midway we planned 
the ultimate essays which were to record our work. Of these 
you know. There was a small book on neural injuries full of 
novelty, a short essay on reflex palsies, etc. One of the most, 
notable was Keen's essay on malingering. Others on epilepsy 
muscular disorders, and on acute exhaustion were never written 
because of accidental destruction of notes by fire. The full notes 
on cases of acute exhaustion would have entirely anticipated the 
delineation of the condition we now accept as neurasthenia. 
Some of our conclusions in regard to these subjects found a place 
in my later volume. 

In this hospital massage was first used to restore action to 
limbs in which healing nerve wounds left the muscles palsied, or 
for the rigidity of splinted cases. 

Here atropine was first employed hypodermically for muscular 
spasms, and here first the combination of atropine and morphine 
was used, and the results recorded in a paper. Our studies of 
the influence of nerve lesions on nutrition and temperature on 
wounds of the sympathetic and reflex palsies are now a part of 
common medical knowledge, but were at that time brilliantly 
fresh. 

Added interest came from the fact that the victims were men 
worn out from fever, dysentery, and long marches; hence was it 
that some of the symptomatic expressions have never been seen 
since in like intensity. The chapters on the neuralgias of wounds 
and causalgia were received in England with sharp critical 
doubts as reporting cases before unheard; and so, indeed, they 
were. In one year 40,000 injections of morphine were used, but 
time lacks to describe cases of neuralgia of such intensity that the 
pain was increased by the vibrations of band music, the rustle of 
dry paper handled. I have seen men pour water into their boots 
to lessen the vibration which the friction in walking caused. No, 



MITCHELL : RECOLLECTIONS OF THE CIVIL WAR / 

I have encountered no such cases since. And, too, we had 
hospital gangrene. I leave Dr. Keen to speak of this appalHng 
ravage. 

I have kept you long enough and said not half I had in mind. 
It would, however, be interesting to entertain you with the matter 
of malingering, but this, too, I leave to Dr. Keen. 

I permit myself to say that a few years ago, with the utmost 
difficulty, Dr. John K. Mitchell re-examined all the survivors 
of nerve wounds whose cases were detailed in our papers or in 
my later work, and who could be found for personal study. This 
uimsual and difficult task added a valuable chapter to our knowl- 
edge of nerve injuries. 

When in June, 1865, our ward work was at an end, the new 
surgeon-general ordered that all of our notes be turned over to 
the department. As the unused cases were of value to us 
alone, we were much troubled. At once we copied or employed 
persons to copy this whole mass of records, thousands of pages, 
and within a fortnight turned over to the surgeon-general these 
original case-books. 

Long afterward Dr. Da Costa Uimented to me that he had 
obeyed the order, and somewhere (pigeon-holed) are many of the 
valuable observations of that brilliant student of disease. We were 
told then that we had been insubordinate,but we were out of service, 
and I remain pleased that for once in my life as an army surgeon 
I disobeyed my superior. 

A word more to close this too disconnected effort to revive 
memories of a great contest. It were desirable that next winter 
we gather here some confederate surgeons to tell us the sad stoiy 
of the surgery and medicine of war under less propitious circum- 
stances. 

The war so trained vast numbers of country doctors that for a 
long time the cases for grave operations ceased to be sent to the 
cities as had been usual. The constant mingling of men of high 
medical culture with the less educated had also value, and the 
general influence of the war on our art was, in this and other 
ways, of great service. 



013 704 714 7 

8 MITCHELL: RECOLLECTIONS OP THE CIVIL WAR 

We had served faithfully as great a cause as earth has known. 
We had built novel hospitals, organized such an ambulance 
service as had never before been seen, contributed numberless 
essays on disease and wounds, and then passed again into private 
life, the unremembered, unrewarded servants of duty. 

The history of this College is to be credited with Fellows who 
created, organized, and conducted the Medical Museum and Medi- 
cal Library in Washington, who made the unequalled catalogue, 
constructed many of the great pavilion hospitals, planned and 
carried out the vast volumes of the medical history of the war, 
and who did more for the general scientific literature of the war 
than all the rest of the army medical service. 

The total number of living Fellows of the College of Physicians 
on the list dated 1864 was 174. A number of these (130) were 
connected in one way or another with the service of the army or 
navy during the four years of that bloody struggle. These gentle- 
men were either regular surgeons, assistant surgeons, or acting 
assistant surgeons. 

Certainly this is a record of honor of which the College may 
well be proud. 



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